“A couple years ago, Sibel Blau, an oncologist outside of Seattle, was working with the company Guardant Health to test their novel ‘liquid biopsies’ in patients. The idea behind liquid biopsies is both elegant and promising. A doctor takes a blood sample from a patient, and then Guardant looks for tumor DNA floating in the blood, allowing doctors to identify the tumor’s unique mutations and offer a personalized drug regimen—all without an invasive tissue biopsy. Blau was excited to be on board.

“When that study wrapped up, Blau still had Guardant test kits left over, so she offered some to her patients at no cost to them. At this point, Blau was routinely ordering DNA sequencing of traditional tissue biopsies, so some patients got both tests. The tissue DNA test from Foundation Medicine was “routine” in her practice, but even that test had only become available in 2012. The field of cancer DNA has been changing fast.”

“Shortly after his mother died of cancer two years ago, Jeff Ettinger, then-chief executive of Hormel Foods, asked the company’s specialty division to explore how to help people undergoing treatment or recovering from it.

“The timing was right. The Cancer Nutrition Consortium, a group of U.S. cancer researchers, was looking for a food manufacturer to produce nutritional products based on what they saw was a gaping need. Patients undergoing chemotherapy tend to experience extreme fatigue, unintentional weight loss and suppressed appetite and energy.

” ‘You feel like you finished the New York marathon and have no energy to cook,’ said Dr. Bruce Moskowitz, a Florida physician and consortium board member. ‘Many people end up going to a fast-food restaurant to take home a meal, which is not the nutrition they need.’ ”

“After decades of frustration, efforts to develop antibodies that can ferry drugs into cancer cells — and minimize damage to healthy tissue — are gathering steam. The next generation of these ‘weaponized antibody’ therapies, called antibody–drug conjugates (ADCs), is working its way through clinical trials.

“Researchers will gather to discuss this renaissance on 30 November at the Symposium on Molecular Targets and Cancer Therapeutics in Munich, Germany. The improvements come after the first wave of experimental ADCs failed to deliver on its promise.

” ‘Initially there was a lot of excitement, and then slowly many of them did not work,’ says Raffit Hassan, a cancer researcher at the US National Cancer Institute in Bethesda, Maryland. Now, he says, there are two new ADCs in phase III clinical trials, and many more in earlier-stage testing.”

“The promise of personalized cancer medicine is still a long way off, and it’s questionable whether any personalized approach will ever benefit patients to any significant degree, say two researchers writing in a “sounding board” article published online September 29 in the New England Journal of Medicine.

” ‘Patients love the idea that they have a specific mutation in their tumour and that if they have their cancer gene sequenced, there will be a specific and effective drug that targets their mutation,’ coauthor Ian Tannock, MD, PhD, Princess Margaret Cancer Center and the University of Toronto, Ontario, Canada, toldMedscape Medical News in an email.”

“There’s been a lot of excitement about immunotherapy as a tool to treat cancer. But as leading experts gathered here on Sunday, several struck an unexpected note of caution.

“ ‘Be critical,’ said Dr. Philip Greenberg of the University of Washington, who’s also scientific cofounder of Juno Therapeutics, one of the companies leading the search for immune-based treatments for cancer. ‘Don’t believe everything you hear.’ “

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“Some of the most promising advances in cancer research in recent years involve treatments known as immunotherapy. These advances are spurring billions of dollars in investment by drug companies, and are leading to hundreds of clinical trials. Here are answers to some basic questions about this complex and rapidly evolving field.

“Immunotherapy refers to any treatment that uses the immune system to fight diseases, including cancer. Unlike chemotherapy, which kills cancer cells, immunotherapy acts on the cells of the immune system, to help them attack the cancer.

“Drugs called checkpoint inhibitors are the most widely used form of immunotherapy for cancer. They block a mechanism that cancer cells use to shut down the immune system. This frees killer T-cells — a critically important part of the immune system — to attack the tumor. Four checkpoint inhibitors have been approved by the Food and Drug Administration and are on the market. They are given intravenously.”

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“Steve Cara expected to sail through the routine medical tests required to increase his life insurance in October 2014. But the results were devastating. He had lung cancer, at age 53. It had begun to spread, and doctors told him it was inoperable.

“A few years ago, they would have suggested chemotherapy. Instead, his oncologist, Dr. Matthew D. Hellmann of Memorial Sloan Kettering Cancer Center in New York, recommended an experimental treatment: immunotherapy. Rather than attacking the cancer directly, as chemo does, immunotherapy tries to rally the patient’s own immune system to fight the disease.

“Uncertain, Mr. Cara sought a second opinion. A doctor at another major hospital read his scans and pathology report, then asked what Dr. Hellmann had advised. When the doctor heard the answer, Mr. Cara recalled, ‘he closed up the folder, handed it back to me and said, ‘Run back there as fast as you can.’ ”

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“Mark Perkins considers himself a poster child for the new generation of cancer drugs that harness the patient’s immune system to attack sick cells. Two years after trying Merck & Co.’s Keytruda — and almost four years after receiving a prognosis of as little as six months left to live — he is cancer free.

“The 56-year-old grandfather’s case is more than a success story for a new class of treatments that have fewer side effects than standard chemotherapy. It’s also at the frontier of what could possibly lead to a new approach to treating cancer, if it turns out that patients who, like Perkins, have many more mutations in their tumors than the average have a better chance of responding to immunotherapy.

“Drugs like Keytruda, known as checkpoint inhibitors, have produced dramatic responses in some advanced cancer patients, but doctors still don’t understand why only about 20 percent gain long-term survival. Researchers say looking at the mutation load for answers makes scientific sense, because these drugs work by taking the brakes off the immune system’s killer T-cells, unleashing them to go after cancerous cells. In theory, the more mutations a cancer has, the more foreign it will appear to the newly enhanced immune cells.”

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